Challenges and opportunities in achieving healing.

The current health care system in the United States must shift from a primary focus on acute care and cure to also emphasize maintenance of function and the relief of suffering that derives from the ailments associated with chronic disease and illness. To achieve this goal, the individual components of the health care equation must all respond and work in concert. These components include the provider, the venue, the patient, the community, our society, and the fiscal realities of paying for care. However, the barrier for change stems from the marked heterogeneity that exists in the definition of each of these individual components. Thus, the fundamental question is, can our current and future medical care system respond to the imperative of focusing on healing with a particular emphasis on chronic diseases? A solution is the provision of individualized care in a mindful practice and the purposeful cultivation of a healing relationship suffused with compassion and empathy in the therapeutic alliances between patient, provider, and advocates.

Toward optimal healing environments in health care.

The 2nd American Samueli Institute symposium was held January 22-25, 2004. The focus of this meeting was an exposition of optimal healing environments (OHE) in American health care. Fifty-five (55) invited guests participated; most had written one of the papers in this Supplement. The conduct of the meeting revolved around small group discussions and two plenary sessions. The ensuing dialogue refined and organized the definitions, components, and research protocols associated with creating and implementing an OHE. This Supplement contains both the invited papers and an abstract of the plenary session discussions.

Ginger syrup as an antiemetic in early pregnancy.

CONTEXT: Ginger (Zingiber officinale) has been used to ameliorate symptoms of nausea. A beverage containing ginger in a syrup may be easier to consume than a capsule or solid food. OBJECTIVE: To determine if ginger syrup mixed in water is an effective remedy for the relief of nausea and vomiting in the first trimester of pregnancy. DESIGN: Double-blind, placebo-controlled, randomized clinical trial. SETTING: Subjects were enrolled from the University of South Florida department of obstetrics and gynecology private practice office. PATIENTS: 26 subjects in the first trimester of pregnancy. INTERVENTION: Subjects ingested 1 tablespoon of commercially prepared study syrup (or placebo) in 4 to 8 ounces of hot or cold water 4 times daily. MAIN OUTCOME MEASURES: Duration and severity of nausea and vomiting over a 2-week period measured on a 10-point scale. RESULTS: After 9 days, 10 of the 13 (77%) subjects receiving ginger had at least a 4-point improvement on the nausea scale. Only 2 of the 10 (20%) remaining subjects in the placebo group had the same improvement. Conversely, no woman in the ginger group, but 7 (70%) of the women in the placebo group, had a 2-point or less improvement on the nausea scale. Eight of the 12 (67%) women in the ginger group who were vomiting daily at the beginning of the treatment stopped vomiting by day 6. Only 2 of the 10 (20%) women in the placebo group who were vomiting stopped by day 6. CONCLUSION: The ingestion of 1 g of ginger in syrup in a divided dose daily may be useful in some patients experiencing nausea and vomiting in the first trimester of pregnancy.

Unreliable medical information on birth certificates.

OBJECTIVE: To compare selected maternal, obstetric and newborn medical information on live birth certificates to medical record abstracted data. STUDY DESIGN: The Florida Department of Health provided a computer tape containing the Hillsborough County Florida live birth certificate data for July 1, 1992, through December 31, 1996. This information was compared to selected maternal, obstetric and newborn medical data abstracted from the hospital records of women who delivered in that county. RESULTS: Three hospitals provided care for 75% (44,654) of all deliveries in the county in the study period. There were no differences in age, race, gravidity or parity of patients between the data sets. There was no concurrence between the number of patients on the state-compiled birth certificate data and the medical record data in 8 maternal medical complications, 5 complications of labor and delivery, 3 obstetric procedures, 3 abnormal neonatal conditions or 7 congenital anomalies from any hospitals. There was no difference between the three hospitals in the incidence of mismatches. CONCLUSION: The medical information on the birth certificates from this county was discrepant from that abstracted directly from the patients' medical records. Caution is required in drawing conclusions from these data sets.